Organization
VAXONSITE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SEAN P CURTIN (PRESIDENT/CFO)
(727) 489-4358
Entity
Organization
Contact information
Practice address
1434 JAM LN, ODESSA, FL 33556-3704
(727) 489-4358
(813) 342-7934
Mailing address
PO BOX 1166, ODESSA, FL 33556-1051
(727) 489-4358
(813) 342-7934
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
HCC10745
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC10745
AHCA - HEALTH CARE CLINIC LICENSE # HCC10745
FL
Enumeration date
09/16/2016
Last updated
09/16/2016
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